Individual provider Active NPI

Henry Douglas Ruther, DMD

  • Dentist
  • Chicago, IL
National Provider Identifier
1477284925
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019.033707 Issued in IL
Practice address
2062 N Milwaukee Ave
Chicago, IL 60647
Phone
(773) 384-3500
NPI assigned
Jun 23, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019.033707 IL Primary

Addresses

Primary practice location

2062 N Milwaukee Ave
Chicago, IL 60647

Mailing address

405 N Wabash Ave Unit 3002
Chicago, IL 60611-5673

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
019.033707ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Flavia Lamberghini PC Past Accepting new patients
Young Esthetics PastSince Jun 26, 2022 Accepting new patients
Star Smiles Orthodontics and Pediatric Dentistry Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655942400000",
    "number": "1477284925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 N WABASH AVE UNIT 3002",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2062 N MILWAUKEE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60647",
            "telephone_number": "773-384-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTHER",
        "first_name": "HENRY",
        "middle_name": "DOUGLAS",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-23",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.033707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.